9:32 AM

From the Frontlines in China

I still follow very closely the Chinese adoption community even though we have committed to Thailand. It does share many similarities, and is a great resource because of it's shear size and length of program, the evolution of it is fascinating and the children who are growing up now are an invaluable resource for me. There have been rumours this past year that the situation in the Chinese orphanages is not what it was/should be and that non special needs adoption would be impossible for international adopters. There were rumours that is was coming from circumstance, policies or both, but regardless it was coming and it was coming now. So when our time came I headed these rumours, they have been so right in the past and chose Thailand. Now for the first time I am hearing reports of what we all worried might be true. I am reposting this blog entry in its entirety rather then linking because I want to a record of it in my own blog.
From the blog Adoption Talk:

Sunday, July 11, 2010
Amy Eldridge of LWB Speaks
The BEST adult session at the Chinese Heritage Camp was the talk by Amy Eldridge of Love Without Boundaries. She spoke about the changing face of Chinese adoption and about the current challenges of orphan care in China. It was emotional, informative, and fascinating. I'll try to report it all, but I hope others who were there will add anything I missed. Amy spoke for almost 2 hours, so I don't think I could possibly remember it all!

Amy first talked about the immense changes in China adoption in the past 10 years. The landscape has changed considerably from the days when Chinese orphanages were filled with healthy infant girls who had been abandoned because of the government's one child policy and the social preference for boys. Now, the orphanages are filled with special needs kids, many critically ill. She reported that 98% of newly abandoned children in China have serious medical needs, which explains why 60% of adoptions in 2010 were special needs adoption.

Why the significant change? First, she said, there has been a growth in more modern attitudes about girls. It is really only in the rural areas that the social preference for boys remains. Ten years ago, 85% of the Chinese population lived in rural areas. Now, only 50% are rural, 50% urban. With that urbanization has come more education, the internet, and the like, which has led to more modern attitudes. Second, there has been growth in the availability of ultrasound technology. Now, anyone who is pregnant can know the child's sex. Anyone who carries a girl to term does so knowingly and with every intention of parenting her. Those who want a boy instead will have an abortion. Third, domestic adoption in China is growing rapidly. That's caused in part by the public interest in adoption after all the news reporting about the orphans of the Sichuan earthquake. And another factor is the increased rate of infertility in China. One government agency estimates that as many as 40 million couples in China are infertile. Infertility is skyrocketing because of increased premarital sex without much sex education, causing increased rates of STDs and frequent abortions that might be less than sterile and because of environmental toxins and pollution. Domestic adoption is preferred by orphanage directors, because domestic adopters pay higher fees than international adopters. In Guangzhou, domestic adopters pay fees of $15,000 to the orphanage; in Hefei, the fee is $7,000 for domestic adopters. Most adoptions are handled on the county or provincial level, even though the CCAA now has a national office of domestic adoption. Orphanages just don't send the files of healthy infants for international adoption when they can place the child domestically.

So, for these three reasons, there are fewer and fewer healthy infant girls available for international adoption. And there has been skyrocketing abandonment of special needs children. One reason for that is the increase in children in China born with birth defects. Birth defects in China have increased 40% since 2001. It is estimated that 1 in 8 to 10 children born in China have birth defects. There are a number of theories about why the rate of birth defects is so high in China, but most believe it is environmental exposure -- after all, in a recent list of the 20 "dirtiest" cities in the world, 16 of them were Chinese cities. In one area of Shaanxi Province, where there is considerable coal production and other environmental hazards, it's reported that the birth defect rate is 85%.

Special needs children get abandoned because of the stigma associated with disabilities and/or because of medical costs. Extended family, espcially the mother-in-law, will insist that a disabled child be abandoned becasue the child is considered unlucky, a curse on the family. Children with visible disabilities will be refused education, and when they grow up will have difficulty finding a job. Medical costs can be too high for a family to bear -- there is no health insurance, no free health care in China. All health care has to be paid for up front. Even if you're in an accident, you won't be treated until your family shows up to pay the bill first. There are no emergency rooms in China. Poor families will abandon their children in the hopes that they will receive health care in the orphanage. Amy said LWB has to be careful about media reports in China, because if there is a story about them doing medical work in an area there's a sharp spike in the abandonment of special needs kids there. She also talked about my FAVORITE fund at LWB, the Unity Fund, which provides free life-saving medical treatment so that poor families don't have to abandon a sick child. I think we all know that adoption is not the solution to the orphan crisis, only preventing children from being orphaned in the first place will solve it.

So how has the increase in special needs abandonment affected orphan care in China? Think about how overwhelmed nannies might be with a room full of healthy kids to take care of. Now think how overwhelming it would be with the same nannies with the same training or lack thereof and the same resources taking care of a roomful of special needs kids. Amy talked about walking into a typical orphanage "baby room" and thinking it should be a hospital ward instead. Nannies will also have the same fear of "unlucky" disabled children as others in China, and may not want to care for a child with albinism or a visible disability.

Two of the biggest needs, then, are education/training for orphanage staff and financial resources. LWB does both. Some of their training is with orphanage directors to help them prepare files on special needs kids to submit for adoption. They sometimes have to encourage the directors to submit files, since the directors will harbor the belief that no one would want to adopt a child with particular disabilities. They also help them make the files more appealing, like encouraging them to have the children smiling in their referral picture, something that culturally isn't the norm in China. Amy related that she told a group of 100 directors in a meeting that it was especially important for the boys to be smiling, since Americans were less willing to adopt boys. She said the room simply erupted in disbelief. They absolutely couldn't believe that girls would be preferred to boys! The directors are still more likely to submit files on boys than girls.

The poorest orphanages in China might get from the government only $25 per child per month, and formula could cost $20 per child per month. Then there is salaries for nannies, power, clothes, other food, and there isn't much left over for medical care. Those orphanages that haven't done international adoptions don't have loyal parents who are willing to help out; adoptive parents want to help their child's orphanage.

The CCAA has two initiatives for medical treatment of special needs kids, but both have their limitations. First is the Tomorrow Plan which provides surgeries for orphans. They've funded 6,000 cleft surgeries alone since its inception in 2004. But it takes too long to process applications, so it can't help children who are in immident need for surgeries or other medical treatment. The plan also designates the hospitals the orphanage must use, and in some areas, the orphanages refuse because they feel the designated hospital is inadequate. The second program is the Blue Sky Initiative. China is building mega-orphanages that can house 600 children, and has on-site medical care and therapy. But there are none in rural areas. And, in places with such mega-orphanages, they are pulling children out of foster care to return them to the orphanage. Amy says they are watching closely to see if there are worse outcomes for children no longer in foster care.

Even with these initiatives and with all LWB and other orphan care organizations can do, Amy said that adoption into a loving home does more for a child than anything else. In China there is a significant stigma about being an orphan. In many areas, orphans cannot go to school outside the orphanage, and in the areas where they can go, they go to the worst schools. They won't be admitted into better schools because parents won't pay for their children to go to school and sit next to an orphan. Companies wouldn't hire an orphan, either, since orphans are considered bad luck. LWB paid for the schooling for the first orphan in Guangzhou to go to and graduate from college. She earned a degree in accounting, and couldn't find a job because employers were afraid that she would bring bad luck to the financial bottom line. She eventually found a job with a foreign company. Another orphan who graduated teacher's college was hired by LWB because no one else would.

Amy also said that adoptive parents need to be prepared before adopting. When they have seen disruptions of adoption in China -- where adoptive parents decide not to go through with a special needs adoption even before returning home -- it's usually because they have not been adequately prepared. She received a call from a family who had switched from the NSN program to the special needs program to adopt a cleft child who had been an LWB child. LWB had repaired her lip, though her palatte repair needed to be done when she was older. Amy knew the child was perfectly healthy, chubby, interactive -- everything you'd want from a institutionalized child. The dad said to her, "Do you know that when she drinks her bottle, milk comes out of her nose?" Duh, yes, Amy knew that and the family would have known that if they had read ANYTHING about cleft-affected children.

Finally, Amy talked about orphanage conditions that adoptive families need to be aware of, so they can understand some of the issues their children may face.

First, as to attachment, APs need to be aware that children may have had numerous changes in caretakers. A child might spend time with birth parents, especially since there's been an increase in older-child abandonment in China. Then the child might spend time with the person who found her, who thought she might keep the baby before the neighbors or extended family said she wouldn't be allowed to.So the child is turned over to the police, who might keep the child for a few days before turning the child over to the orphanage. The child might be in quarantine for a month at the orphanage who is trying to avoid the spread of HIV or Hep C. Then the child enters the young infant room, and then in a few months to the older infant room, and then the toddler room or foster care. And the child in foster care may be returned to the orphanage for two weeks before the adoptive parents come. With a special needs child who might have had hospitalizations and/or surgeries, the child would likely be alone at the hospital through all of this. The orphanage can't spare the nanny who might have been the primary caregiver, so they might send a groundskeeper to take the child to the hospital and then leave her alone. In Chinese medicine, there is a great reluctance to give children pain medication, so post-operative time will be painful and scary for a child alone. All of this affects attachment.

Second, children may have feeding issues. Overcrowded orphanages don't have the time to hand-feed children, so bottles are propped and often boiling hot. Solid food is beyond the resources of the orphanage, and most orphanages can't afford meat. Newborns might wait 5-6 hours between feedings. Infants might wait 12 hours. There won't be between-meal snacks for toddlers or older children. Children are often hungry all the time, never feeling full. From this, you can expect aversion to certain food textures, no ability to suck, food hoarding, gorging, no off-switch when eating because no feeling of being full.

Third, children might experience "irrational" fears that aren't so irrational after all. They would often be alone in the dark at night, with only a skeleton orphanage staff on hand. There might be bugs and rats in the dark. Fear of the dark, of thunderstorms, of animals, of bugs, are not irrational fears for these children. Adoptive parents can't know what their children experienced in the orphanage, so must be understanding of these fears.

Whew! That's all I remember -- if you were there, and want to add or correct, please comment! As I said, it was an amazing presentation. I was happy to meet Amy Eldridge and thank her at the end of her presentation, and she was kind enough to say she loved my blog (brag, brag)! If you ever have an opportunity to hear Amy speak, run, don't walk, to hear her!